Homeless people remain at a greater risk of cardiovascular disease (CVD) based on uncontrolled risk factors, poor access to healthcare and difficulties adhering to long-term management, according to the authors of a review published May 28 in the Journal of the American College of Cardiology.
Separate reports estimate there are 550,000 homeless individuals on a given night in the U.S. and up to 3.5 million who experience homelessness at some point over the course of a year.
These individuals experience a greater burden of both traditional and nontraditional risk factors for CVD, wrote the review authors. They are more likely to smoke than the general population, and although their prevalence of diabetes and hypertension is similar, it is less likely to be treated. In addition, homeless individuals are more likely to contract HIV, abuse alcohol and cocaine and experience chronic stress and depression—all of which can heighten cardiovascular risk.
Deaths from heart disease are two to three times more likely among homeless adults aged 45 or older when compared to similarly aged people from the general population, according to a 2013 study.
“Clinicians need to make a concerted effort to overcome the logistical hurdles to treating and preventing cardiovascular disease in homeless populations,” lead author Stephen W. Hwang, MD, MPH, director of the Centre for Urban Health Solutions of St. Michael’s Hospital in Toronto, said in a press release. “Half of homeless individuals don’t have access to a consistent source of health care, making follow-up visits and lengthy diagnostic tests a challenge. It’s our duty as health care providers to adjust our practices to provide the best possible care for these vulnerable patients.”
Currently, homeless individuals are more likely to show up at emergency departments with advanced disease states. This creates a cycle of care addressed at meeting immediate needs rather than long-term management of conditions, the authors pointed out.
Hwang et al. said finding ways to limit the smoking prevalence in this population is particularly crucial, considering that 60 percent of ischemic heart disease deaths among homeless people can be attributed to tobacco.
“Most homeless smokers want to quit smoking, but quit rates in this population are one-fifth of the national average,” the authors wrote. “Although several studies have examined smoking cessation interventions for homeless smokers, the negative results or pilot nature of these studies means that the optimal approach to addressing tobacco use in this population is uncertain. We strongly encourage the use of pharmacotherapy for smoking cessation, and we offer quitline referrals to individuals with mobile phones.”
Once cardiovascular disease is identified among a homeless individual, the reviewers said, earlier and more frequent follow-up visits should be scheduled to minimize the risk of losing track of the patient. Recent studies have shown that 44 to 89 percent of homeless people have cell phones, representing an opportunity to send appointment reminders via text message.
In addition, Hwang and colleagues said counseling efforts should be devoted to preventing substance abuse and recommending incorporating physical fitness and the best possible diet into these patients’ daily routines.
However, a lack of adequate medical insurance and the unaffordability of some interventions and medication regimens likely contributes to nonadherence, the authors acknowledged.
“Multidisciplinary collaboration with primary care providers and behavioral health specialists may be needed to address homeless patients’ complex needs and to optimize their cardiovascular outcomes,” they wrote. “Homeless-tailored care models exist in most U.S. cities and can be a valuable resource for achieving these goals and reducing the burden of CVD morbidity and mortality among those experiencing homelessness.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.